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Thursday, November 15, 2012

Patient Bill of Rights- Your right to refuse.

Every year for my hospital-based jobs, I have to complete yearly competencies. These competencies are computer based presentations and then quizzes over the content presented. Typically, the topics covered include HIPAA, patient safety, corporate compliance, etc.

Yesterday morning, while working a shift, I completed a competency discussing the Patient's Bill of Rights.

You all know what the Bill of Rights is, yea? (I hope so!)

The hospital version is very similar to the concept of our national Bill of Rights, in that it seeks to protect your basic rights and freedoms- only as a patient.

At every hospital you attend, there will be (somewhere) a posted Patient Bill of Rights. In most cases, you can find the Patient Bill of Rights for your specific hospital or medical center by just looking at their website- as many facilities have it stated directly in clear terms on their site.

There are many things that a Patient Bill of Rights includes, such as being entitled to knowledge of the following: available services and providers, diagnosis and treatment options, hospital charges and fees, etc.

One other area that caught my eye was that each patient has the right to refusal of medication and treatment.

As I sat and read through the Patient Bill of Rights competency, I thought for a good while about my typical patients/clients and how I proceed with their care. In speech pathology, there are a large number of clients who have trouble eating and drinking. As my clients age, we see decreased functional muscle reserve coupled with multiple diagnoses and comorbidities that cause the act of eating and drinking to become very difficult and often dangerous.

However, in most of these cases, there will be some sort of "Quality of Life" discussion. If a client is nearing the end of their time with us on earth, we always discuss just how much change they are willing to make. In some cases, patients will refuse either surgical or dietary change related interventions- after being informed and educated of the risks this choice presents and the possible consequences of that choice- in order to continue to eat for pleasure and quality of life.

With this type of case- and many other cases in the hospital where a patient refuses a procedure or treatment- it is their choice. I provide all the information to them in a calm, educational manner, and they are then left to decide, for their body and their life, what the correct path may be.

And then we look to maternity care.

During little man's birth, knowing what I do about the hospital and patient rights and protections, I listened very carefully to how they posed suggestions and recommendations.

Not once did someone (a doctor or nurse) come into my labor room, sit down calmly with me, and discuss the options I have.

When a doctor (or typically nurse) would enter the room with their recommendations to do something differently- for example: when they wanted me to start pitocin- they would walk in, stand next to me for a moment or two, say that they would like to give me pitocin for XYZ reasons, and then wait for my response.

Not once did that healthcare professional say what my other options were, how long I had to make that decision (until I pressed them for more time), or what were all the possible consequences of if I didn't follow their procedure or treatment recommendation. Sure, when I pressed for more time and gave indications of NOT wanting to allow their interventions, they told me the worst case scenarios about what would happen to my baby (fear mongering, anyone?), but no one ever told me other scenarios.

Additionally, later in my delivery when I did ask for specific requests while birthing my son (such as no episiotomy and please don't count to ten for me while I'm pushing)- my requests were either ignored as they counted anyway, or they were continued to be discussed as an option even after I explicitly said no in regards to the episiotomy.

As a healthcare provider, as a mother, as a woman... we need to do better.

Yes, birth is a complicated experience, with possibilities to go wrong all up and down the path we walk to the child's entry into this world. But so is a heart surgery, radiation treatment, or blood transfusion.

We do such an excellent job as care providers making our clients aware of all these situations/options/choices in almost EVERY area of health other than maternity care.

And why?

A life is a life, whether it is a baby or child's life or an elderly client's life. Neither is more important than the other, and both deserve to know all of the possible choices and options.

Because we as health professionals don't have the final say.

In the end, it is that mother's body and baby and choice, just as it is my elderly client's body and choice. Just because there is a child involved, it gives me no further right to make decisions for that patient and family than I would have for any other patient.

If you are a healthcare professional- especially one working in labor and delivery- please think about how you approach your patients and clients. Can you do better? Can you explain more? Can you spend more time helping your patients through these decisions? Can you take your own personal experiences or history out of the equation with other deliveries and look at each mother as a unique individual with unique needs?

As an expecting mother and possible patient of a hospital, I urge you to speak for yourself. Ask why, ask what your other options are, ask how much time you have to make those decisions. If you are only given half the information, the choice you're making may not always be the best one for you, even if your doctor believes it to be so.

Hopefully, by both patients and professionals working steadfastly to improve our maternity care, we can proceed to better patient outcomes for both mothers and babies.

4 comments:

This is a really good post. I'm a first time mom and I'm most afraid of being pushed into procedures, medications ect that I might find out later weren't 100% necessary. Do you have a birth plan/ list of things that you're going to refuse or question? How does it work when you're making discussions for your baby after birth?

We do have a birth plan, it is very similar to our birth plan with little man, but I'll be posting it soon!

There are basically three questions that I ask now: 1) What are my other options? 2) How long do I have to make the choice of what I want to do? and 3) What are ALL the possible outcomes if I choose to not do what you are recommending?

I find that by asking those three questions, you obtain the information you require to make the right decision for your baby and your body.

I really liked this. And honestly, this was one of the reasons I felt more comfortable having a natural birth outside of the hospital. I knew that I wanted a completely unmedicated birth.. and I feel like a lot of times that is not respected in the hospitals. I didn't want to have to deal with someone trying to convince me (WHILE giving birth!!!) that I needed pitocin, epidural, episiotomy, etc. when I already knew that I wasn't going to be doing any of those things.

I think sometimes mothers just assume that the doctor always, 100% knows what is best (and that is just not always the case).. so they don't ask any questions.. they just oblige to whatever the doctor wants.

Check out The Business of Being Born, if you haven't already. It's a documentary, and it's on Netflix instant to make life easier. It really opened my eyes to the options families have, and how little-known these options are. It brought tears to my eyes to read how you had a specific birth plan and it was as though you never made one at all! We are trying to conceive now, and I am already researching an OB-GYN/Midwife who will commit to our birth plan,whatever we decide. I am an SLP, too, and gosh-patient's opinions count, too! The notion of MD knows all saddens me, and is not even true, as it takes a team to make the right choices. :/